Use of methylene blue for refractory septic shock during continuous venovenous hemodiafiltration.

Joshua C. Mount, A. Shaun Rowe

Research output: Contribution to journalArticle

Abstract

As an inhibitor of nitric oxide, methylene blue has been investigated as an alternative vasopressor in patients with septic shock refractory to catecholamine vasopressors and as an agent to maintain hemodynamic stability in patients receiving intermittent hemodialysis. However, to our knowledge, the use of methylene blue as a vasopressor in patents receiving continuous renal replacement therapy has not been evaluated. We describe a 56-year-old man who was receiving continuous venovenous hemodiafiltration (CVVHDF) for acute renal failure secondary to sepsis. After a difficult hospital stay for injuries sustained from a motor vehicle accident, the patient developed sepsis and subsequent renal failure. On hospital day 47, after an adequate course of antibiotics, the patient developed refractory shock while receiving norepinephrine, phenylephrine, vasopressin, and hydrocortisone. He was then given a continuous infusion of methylene blue, which increased his mean arterial pressure and allowed for weaning of the catecholamine vasopressors. Eight hours after the start of methylene blue, the CVVHDF filter failed, and the hemodiafiltration was stopped. Because the filter was blue, a sample of the patient's effluent was analyzed by using ultraviolet-visible spectroscopy. No methylene blue was detected in the sample, suggesting that the drug was not being removed by CVVHDF. Clinicians should use caution when they are considering the use of methylene blue in patients with refractory shock who are also receiving CVVHDF.

Original languageEnglish (US)
Pages (from-to)323
Number of pages1
JournalPharmacotherapy
Volume30
Issue number3
StatePublished - Mar 2010
Externally publishedYes

Fingerprint

Hemodiafiltration
Methylene Blue
Septic Shock
Catecholamines
Shock
Sepsis
Renal Replacement Therapy
Patents
Phenylephrine
Vasoconstrictor Agents
Motor Vehicles
Weaning
Vasopressins
Acute Kidney Injury
Accidents
Renal Insufficiency
Renal Dialysis
Hydrocortisone
Length of Stay
Spectrum Analysis

All Science Journal Classification (ASJC) codes

  • Pharmacology (medical)

Cite this

Use of methylene blue for refractory septic shock during continuous venovenous hemodiafiltration. / Mount, Joshua C.; Rowe, A. Shaun.

In: Pharmacotherapy, Vol. 30, No. 3, 03.2010, p. 323.

Research output: Contribution to journalArticle

@article{155333aae31f40a7b6ccc6a754429565,
title = "Use of methylene blue for refractory septic shock during continuous venovenous hemodiafiltration.",
abstract = "As an inhibitor of nitric oxide, methylene blue has been investigated as an alternative vasopressor in patients with septic shock refractory to catecholamine vasopressors and as an agent to maintain hemodynamic stability in patients receiving intermittent hemodialysis. However, to our knowledge, the use of methylene blue as a vasopressor in patents receiving continuous renal replacement therapy has not been evaluated. We describe a 56-year-old man who was receiving continuous venovenous hemodiafiltration (CVVHDF) for acute renal failure secondary to sepsis. After a difficult hospital stay for injuries sustained from a motor vehicle accident, the patient developed sepsis and subsequent renal failure. On hospital day 47, after an adequate course of antibiotics, the patient developed refractory shock while receiving norepinephrine, phenylephrine, vasopressin, and hydrocortisone. He was then given a continuous infusion of methylene blue, which increased his mean arterial pressure and allowed for weaning of the catecholamine vasopressors. Eight hours after the start of methylene blue, the CVVHDF filter failed, and the hemodiafiltration was stopped. Because the filter was blue, a sample of the patient's effluent was analyzed by using ultraviolet-visible spectroscopy. No methylene blue was detected in the sample, suggesting that the drug was not being removed by CVVHDF. Clinicians should use caution when they are considering the use of methylene blue in patients with refractory shock who are also receiving CVVHDF.",
author = "Mount, {Joshua C.} and Rowe, {A. Shaun}",
year = "2010",
month = "3",
language = "English (US)",
volume = "30",
pages = "323",
journal = "Pharmacotherapy",
issn = "0277-0008",
publisher = "Pharmacotherapy Publications Inc.",
number = "3",

}

TY - JOUR

T1 - Use of methylene blue for refractory septic shock during continuous venovenous hemodiafiltration.

AU - Mount, Joshua C.

AU - Rowe, A. Shaun

PY - 2010/3

Y1 - 2010/3

N2 - As an inhibitor of nitric oxide, methylene blue has been investigated as an alternative vasopressor in patients with septic shock refractory to catecholamine vasopressors and as an agent to maintain hemodynamic stability in patients receiving intermittent hemodialysis. However, to our knowledge, the use of methylene blue as a vasopressor in patents receiving continuous renal replacement therapy has not been evaluated. We describe a 56-year-old man who was receiving continuous venovenous hemodiafiltration (CVVHDF) for acute renal failure secondary to sepsis. After a difficult hospital stay for injuries sustained from a motor vehicle accident, the patient developed sepsis and subsequent renal failure. On hospital day 47, after an adequate course of antibiotics, the patient developed refractory shock while receiving norepinephrine, phenylephrine, vasopressin, and hydrocortisone. He was then given a continuous infusion of methylene blue, which increased his mean arterial pressure and allowed for weaning of the catecholamine vasopressors. Eight hours after the start of methylene blue, the CVVHDF filter failed, and the hemodiafiltration was stopped. Because the filter was blue, a sample of the patient's effluent was analyzed by using ultraviolet-visible spectroscopy. No methylene blue was detected in the sample, suggesting that the drug was not being removed by CVVHDF. Clinicians should use caution when they are considering the use of methylene blue in patients with refractory shock who are also receiving CVVHDF.

AB - As an inhibitor of nitric oxide, methylene blue has been investigated as an alternative vasopressor in patients with septic shock refractory to catecholamine vasopressors and as an agent to maintain hemodynamic stability in patients receiving intermittent hemodialysis. However, to our knowledge, the use of methylene blue as a vasopressor in patents receiving continuous renal replacement therapy has not been evaluated. We describe a 56-year-old man who was receiving continuous venovenous hemodiafiltration (CVVHDF) for acute renal failure secondary to sepsis. After a difficult hospital stay for injuries sustained from a motor vehicle accident, the patient developed sepsis and subsequent renal failure. On hospital day 47, after an adequate course of antibiotics, the patient developed refractory shock while receiving norepinephrine, phenylephrine, vasopressin, and hydrocortisone. He was then given a continuous infusion of methylene blue, which increased his mean arterial pressure and allowed for weaning of the catecholamine vasopressors. Eight hours after the start of methylene blue, the CVVHDF filter failed, and the hemodiafiltration was stopped. Because the filter was blue, a sample of the patient's effluent was analyzed by using ultraviolet-visible spectroscopy. No methylene blue was detected in the sample, suggesting that the drug was not being removed by CVVHDF. Clinicians should use caution when they are considering the use of methylene blue in patients with refractory shock who are also receiving CVVHDF.

UR - http://www.scopus.com/inward/record.url?scp=77952571616&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77952571616&partnerID=8YFLogxK

M3 - Article

VL - 30

SP - 323

JO - Pharmacotherapy

JF - Pharmacotherapy

SN - 0277-0008

IS - 3

ER -